The surgeon who performed the most extreme face transplant ever told us how he did it

Patrick Hardison's face burned off while he was working as a volunteer firefighter in 2001. In August 2015, Dr. Eduardo Rodriguez gave him a new one.

It was the most extensive face transplant ever, involving more than 100 people. Dr. Rodriguez's team practiced for more than a year. Once the operation began on August 16, he took just three short breaks, mostly just because he had to use the bathroom.

"A total face transplant with the scalp had never been done," Rodriguez, the chair of NYU's Hansjörg Wyss Department of Plastic Surgery, told INSIDER. "The eyelids are functioning currently on Patrick — that is a hugely important medical accomplishment."

This was not Rodriguez's first face transplant, but it was his most extreme one. The whole procedure took 26 hours: 12 hours to procure the face from the donor, seven hours to remove the scarred face, and ten hours to complete the transplant.

"It's not like a recipe that we follow," Rodriguez said. "No one rests until we're finished. It's kind of what we're mentally prepared to do."

A side-by-side comparison of Hardison's face before and after the transplant.
Reuters
Hardison went through NYU Langone Medical Center's extensive and rigorous screening process, and was finally declared eligible for a face transplant. They don't take everyone. Rodriguez only performs face transplants for patients who have a deformity and have been unsuccessfully treated by conventional surgery. Hardison had more than 70 surgeries over the past dozen years. He was given skin grafts and prosthetic ears. But problems persisted. He didn't have functioning eyelids, and his face remained bone-white.

His face donor was David Rodebaugh. Just two days before the procedure, Rodebaugh was declared brain-dead following a biking accident in Brooklyn earlier this year. LiveOn NY, an organization that matches organ donors with recipients, notified Rodriguez, and the doctor summoned Hardison to come to NYU Langone.

The surgery was immensely complicated. Rodebaugh's face had to be removed with precise, perfect cuts. Rodriguez had to connect every blood vessel, artery, and nerve to Hardison's scalp. As he stabilized the skeleton, reconstructed muscles and tissue, and worked on the fine details of Hardison's lips, eyelids, and neck skin, his focus was laserlike.

As he began the operation, Rodriguez noticed an incision on Rodebaugh's scalp. A neurosurgeon had made it in an earlier procedure. With that incision in place, Rodriguez wasn't sure he could do the transplant. He had to dissect part of the face's vascular system to see if it was healthy enough to handle the operation. He used a new piece of machinery that let him inject a special dye into the face's vascular system to reveal precise details about its vascularity.

"Until I knew that was the case, I did not know if I could remove the scalp," Rodriguez said. "That was the most challenging and unexpected part of the operation."

The NYU Langone Medical Center team that worked on the transplant.
Reuters
I compared Rodriguez's surgery to Ben Carson's separation of conjoined twins in 1987. Rodriguez pointed out that his operation was even more avant-garde.

"This is still considered experimental," Rodriguez said. "Unlike Ben Carson, who was doing conventional surgery."

After 26 hours, Rodriguez and his team completed the operation. When Hardison woke up, he blinked. His eyelids worked.

Hardison's face looks swollen now, but Rodriguez says it'll eventually look normal. Like like any medical procedure, it takes time for everything to heal. It isn't like the movie "Face/Off," Rodriguez said of the movie where Nicolas Cage and John Travolta swap faces, where everyone looks normal right after walking out of the operating theater. Rodriguez will keep a close eye on Harrison's progress for a few months, but the swelling continues to subside daily.

"Patrick will ultimately look normal and function normal," Rodriguez said. "But there's a process, which is part of normal surgical healing."